原发性干燥综合征肾损害的临床分析

发布时间：2018-06-20 21:04

本文选题：干燥综合征 + 肾损害　；参考：《山西医科大学》2014年硕士论文

【摘要】：目的对原发性干燥综合征(pSS)伴肾损害患者及无肾损害患者的临床资料进行回顾性对比分析,进一步研究pSS肾损害的临床特点、免疫学特点及病理学特点和预后,提高对本病的认识,改善预后。方法收集387例住院pSS患者临庆资料,并分为两组,其中合并肾脏损害组的患者198例,189例不合并肾脏损害组的患者为一组。回顾性分析对比两组之间临床表现、血液检查、尿液检查及免疫学特点的差别。分析72例伴肾损害患者的病理特点。结果387例住院pSS患者,其中男42例,女345例,男女之比为1：8.2。198例伴肾损害患者中,其中男30例,女168例,男女之比为1：5.58。两组间临床表现比较：两组间口干、眼干、关节痛、发热、口腔溃疡发生率差异无统计学意义；两组间血清免疫球蛋白IgA、IgM、自身抗体(抗ANA、抗ds-DNA、抗SSA、抗SSB)及补体C3、C4的水平差异无统计学意义(P0.05)；肾脏损害组血清类风湿因子及免疫球蛋白IgG水平明显增高,差异有统计学意义(P0.05)；肾损害组中,以Ⅰ型肾小管酸中毒(RTA)为表现的患者为102例,其中表现为低钾血症者为54例,周期性低钾性麻痹12例,合并骨质疏松6例；以肾小球病变为主的伴肾损害患者共69例,其中36例表现为肾病综合征,33例为慢性肾小球肾炎;81例肾功能不全(40.9%),其中CKD1期27例,CKD2期18例,CKD3期9例,CKD4期15例,CKD5期12例；72例行肾穿刺患者中,69例为慢性间质性肾炎(interstitial nephritis,IN);3例为轻微病变型肾小球肾炎,36例为IN合并系膜增生性肾小球肾炎；9例为增生硬化性肾小球肾炎；局9例为灶节段性肾小球硬化；6例为膜性肾病。72例行肾穿病理患者中33例IgM沉积、21例有IgG沉积、21例IgA沉积、、18例C4沉积、15例C1q沉积、12例C3沉积。随访66例肾活检患者8-30月(中位时间18月)。至随访末,除一例死于脑血管意外外,其余患者全部存活,肾功能正常或好转。结论1.间质性肾炎为pSS患者主要的病理表现,但同时合并肾小球肾炎患者也并不少见； 2.RF及IgG升高分别是pSS肾损害的独立危险因素； 3.肾病理检查有助于pSS合并肾损害患者个体化治疗,改善预后
[Abstract]:Objective to compare and analyze the clinical data of primary Sjogren's syndrome (PSS) with and without renal damage, and to study the clinical, immunological and pathological features and prognosis of PSS. To improve the understanding of the disease and improve the prognosis. Methods 387 inpatients with PSS were divided into two groups: 198 patients with renal damage and 189 patients with no renal damage. The clinical manifestations, blood examination, urine examination and immunological characteristics were retrospectively analyzed and compared between the two groups. The pathological features of 72 patients with renal damage were analyzed. Results there were 387 hospitalized patients with PSS, including 42 males and 345 females. The ratio of male to female was 1: 8.2.198, of which 30 were male and 168 female, the ratio of male to female was 1: 5.58. Comparison of clinical manifestations between the two groups: there was no significant difference in the incidence of xerostomia, ocular trunk, arthralgia, fever and oral ulcer between the two groups. There was no significant difference between the two groups in the levels of serum immunoglobulin IgA, autoantibodies (anti-ANA, anti-ds-DNA, anti-SSA, anti-SSBs) and complement C _ 3N _ 4 (P 0.05), but the levels of rheumatoid factor and immunoglobulin IgG in renal injury group were significantly higher than those in control group (P 0.05). In the renal injury group, 102 patients with type I renal tubular acidosis were found, including 54 patients with hypokalemia, 12 patients with periodic hypokalemic paralysis and 6 patients with osteoporosis. There were 69 cases of glomerular lesion with renal damage, of which 36 cases were characterized by nephrotic syndrome and 33 cases were chronic glomerulonephritis and 81 cases were chronic glomerulonephritis. Among them, 27 cases were CKD1 stage, 18 cases were CKD3 stage, 9 cases were CKD4 stage 15 cases were CKD5 stage 12 cases. In 72 cases of renal puncture, 69 cases were chronic interstitial glomerulonephritis and 3 cases were mild lesion glomerulonephritis. 36 cases were IN complicated with Mesangial proliferative glomerulonephritis. 9 cases were proliferative sclerosing glomerulonephritis. Among the 9 cases of focal segmental glomerulosclerosis, 6 cases were membranous nephropathy. 72 cases were treated with renal puncture pathology. Among them, 33 cases had IgM deposition 21 cases had IgG deposition 21 cases had IgA deposition, 18 cases had C4 deposition, 15 cases C 1q deposition and 12 cases C 3 deposition. A total of 66 patients with renal biopsy were followed up for 8-30 months (median 18 months). At the end of follow-up, all but one died of cerebrovascular accident, and the renal function was normal or improved. Conclusion 1. Interstitial glomerulonephritis is the main pathological manifestation of PSS, but it is not uncommon in the patients with glomerulonephritis. 2. The increase of RF and IgG are independent risk factors of PSS renal damage. 3. Renal pathological examination is helpful to individual treatment of PSS patients with renal damage and to improve prognosis.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R593.2;R692

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